Paul Farmer Interview (page: 8 / 9)

Paul Farmer: Not really, no. My grandparents, my grandmother was, but not so much my dad. He was a free spirit.

What kind of jobs did you have as a teenager, and what did you spend your earnings on?

Paul Farmer: I worked a lot. I remember I worked at a grocery store, as a bag boy, all that stuff. But I spent my earnings on books, often.

Didn't your father and your brothers and you pick oranges?

Paul Farmer: Oh yeah, way back. Yeah, we did. My father had the boat, and he said that he was going to become a commercial fisherman, which sounded cool, and he never succeeded at that, but this boat looks like a giant rowboat, it just was empty. So we had to build an infrastructure on it. We needed cash. That didn't last too long, though. Let me tell you, that's hard work.

Who did you meet? Who else was picking oranges?

Paul Farmer: We didn't really meet people, but there were people coming from Mexico, from Haiti, from all over the Caribbean. But we didn't last long doing that.

Was that the first time you met people from Mexico and Haiti?

Paul Farmer: Probably, except for maybe kids at the school. That part of Florida, it's not like Miami or Orlando. It's not a crossroads. It's in the middle of nowhere. But yeah, that's probably the first. I didn't know how sheltered we were until much later, when I actually went to Haiti. Of course, since then, I've been all over the world, but I'd never been out of the country, except Canada, when I went away to college. I'd only been on a plane once, and now I feel like I live on planes.

Was there an experience or an event that inspired you most as a young person?

Paul Farmer: Not that I would point to, no. Living in a big family, you learn a lot about how to get along with other people, especially when you're in extremely crowded circumstances. I can't point to any single thing. I was just really lucky, it sounds bad to say, but I got to get out. When you're living in a small town, or a village, to go to a research university and discover the world is really a terrific process.

Did you know from a very young age what you wanted to do, or was it an idea that evolved over time?

Paul Farmer: I said that I wanted to be a doctor, but you look back and say, "Why did I say that?" I had no experience with doctors. I didn't really know any. These days, if I'm looking at an application to medical school, looking at his or her statement, I just look back and kind of humbly think, "What was my reasoning for wanting to do that?" So I'm not a real harsh critic of whatever a 22-year-old might say in a medical school application, cause I'm not sure I would have done a good job justifying why I wanted to do it. You can sort of grow into what you want to do. You can grow into your aspirations, I think. Here's one of the examples that I give all the time.

I grew up in a very large family, in a very small space, and I'm very close to my brothers and sisters. But one of my brothers is a pro wrestler on television, and so we had the same childhood experiences. He's now a -- fortunately, no longer wrestling on TV -- but I'm just saying, the idea that you have some experience that makes you into who you are -- I mean that's a very common explanatory device, but you can all come from one family and do very different things, based on the same experiences. So for me, when I said I wanted to be a doctor at a very young age, it turned out I did want to be a doctor, but the reasons for doing it may have changed over time.

Have we heard of your brother?

Paul Farmer: Probably, if you're a big wrestling fan. He was New World Order Sting, he was Super Jay, that was more in Japan and Asia. He got around. He's a big, big fellow.

What was your transition like -- from living with your family in Florida, in a big, communal family -- to Duke University?

Paul Farmer: Well, to go from a bus to a dorm, you're still in a communal living situation. It was great. Like a lot of kids that are 18 getting to go away to college, I think it's a terrific experience.

Culture shock?

Paul Farmer: We're pretty resilient. A little, but not that much. You get caught up in classes, so not really. It was a radically different culture, I'll grant you that, but remember I'm now about to hit 50, so I'm looking back and thinking, "Culture shock? What about Florida to Haiti, or Haiti to Rwanda?" So in terms of what I've seen in the last 25 years, no, that was not a very striking shift of culture. It's still American culture. It was later that I learned more about what culture shock was like, not so much as a student.

Do you think your upbringing contributed to your professional mission, or do you think you were predisposed to public service? Were you hard-wired for service?

Paul Farmer: That's a great question, but I don't think there's an obvious answer to it, because, like I said, I come from a large family. We all shared the same experiences, but we all do very different things. I'm not sure it's hard-wired. I would have argued 20 years ago that it is not hard-wired.

Anybody can learn to be interested in public service, or service to others. You can learn it early or late, and I'm very much someone who encourages that kind of plasticity of engagement. You could be 80 years old, you could be 20. You can still get engaged in service to other people. So I'm not sure that it's hard-wired, but I think you're conditioned. Like, all of my brothers and sisters have very similar sets of expectations of the world, of what we should do for other people, I think, even though we do very different things. So is that hard-wired? Is it the way our parents raised us? Nobody knows for sure. People make very confident claims about the ideology of a certain set of expectations, that is, you're conditioned by your environment. Yeah, but I'm not sure you know now. And I've thought a lot about this, looking at other people's lives. Why do they do what they do as adults? One looks in the obvious places, you know, childhood experiences. But I'm not sure how it works in terms of causality. The good news is, if that's the case, then anybody can get involved in service to other people at any step along the way. Of course, as a teacher of medical students, and of doctors, you want them to get involved in service to other people. That's the whole point in medicine is to think about other people. And I'm convinced that people from all kinds of different backgrounds can do a good job at this.

Were you still at Duke the first time you traveled to Haiti?

Paul Farmer: No, I had just left. I graduated Duke, got some funding to go to Haiti at graduation, and I went afterwards. But I had written about Haiti and Haitians at Duke, but they were mostly migrant farm workers in the migrant farm workers stream that went from Florida all the way up to North Carolina and New York and beyond.

Was that seed planted back when you were picking oranges in Florida?

Paul Farmer: That's speculation, 'cause I don't know. I wasn't the only person in my family who met Haitians back then, or got interested. I suppose the seed was planted. It would be easy to say that, but I'm not so sure. Is that fair enough?

It is tempting to say, "a" leads to "b" leads to "c," but there's a downside to doing that. I guess that's what I'm saying here. If you believe that people are hard-wired to serve others, or that they have to have these experiences, then that excuses everybody else who hasn't had any kind of experience like that from doing this, from engaging in public service. And I don't want to do that 'cause I don't believe in it. I've met kids from incredibly privileged backgrounds who have never known any personal hardship or material hardship, who nonetheless become splendid servants of other people, in medicine or nursing or any one of a series of -- social work, et cetera -- or development work. And they have nothing in common in terms of background. That's the good news. Anybody can do this kind of work.

Who was Claude Lévi-Strauss, and what was his influence in your life?

Paul Farmer: He's a famous anthropologist, cultural anthropologist. Actually the first time I left the country, except for Canada, was when I went to study abroad, in France in 1981, as a Duke student, and sat in on his classes. But again, it was more just the idea of, "Well, here's a life of the mind, and someone who's written lots of books, who's a teacher, and maybe I could do that too." It didn't change the desire to be a physician, but it added sort of an academic discipline. I had professors at Duke who really set me on this path. Later, I would study with some anthropologists at Harvard, and do my Ph.D. under a medical anthropologist. So it was really not so much about the work itself, or his body of work, that ended up being of most interest to me in that field in anthropology. It was the idea of being a professor and writing books. That stuck with me.

What do you know now about achievement that you did not know when you were younger?

Paul Farmer: I think a lot of people, when they're really young, and in their 20s, they are on their own quest for personal efficacy. And I understand that. It's particularly true, I think, for young Americans. I mean, that's the group I know best, obviously. But the sooner that people can discover that it's really about building teams, and not about personal efficacy, I think the better -- the more quickly -- we can move forward. I believe that.

What do you see as the next challenge or the next great frontier in your field?

Paul Farmer: Well, I think that if I define my field as infectious disease, I'd say community-based care for chronic infectious disease, or new therapeutics are in the pipeline. If I define my field as public health, I would say strengthening health systems, right? But if I define my field more broadly, as development and social progress, I would say the biggest developments are going to be bringing together a growing movement around social justice, and linking that to the growing movement for environmental justice. I think once these things come together, that we're going to see a lot of social progress in the planet. So yeah, any of those. That's all optimism for you.